Post traumatic complete facial nerve palsy…
is conservative management appropriate?
DR MADAN GUPTA- ENT AIIMS
DR ALOK THAKAR- ENT AIIMS
DR DEEPAK AGRAWAL-NREUROSURGERY AIIMS
DR ATIN KUMAR-RADIODIAGNOSIS AIIMS
• The recommened treatment for post traumatic complete
facial nerve paralysis has generally been surgical .
Farrior and Caldwell - New Orleans Med Sci J.1947;100:23–25
Tucker and McCabe Laryngoscope. 1978;88:348 –354
Tuncay Ulug American Journal of Otolaryngology–Head and Neck
Medicine and Surgery 26 (2005) 230– 238
• Some recent realization in the literature that surgical
decompression for such injuries may not be always
MATERIAL AND METHOD
Single arm Observational study
Cohort of 35 consecutive cases of post- traumatic
complete facial nerve palsy ( H& B grade VI)
secondary to blunt head injury including cases with
demonstrable fractures of the temporal bone.
2010-2012. , AIIMS main hospital and trauma centre
Informed consent- discussed treatment options and also of the surgical option.
35 pateints were recurited
7 withdrew from the study
Post traumatic grade VI facial palsy
No response on ENoG
Details of evaluation techniques
• Intervention- steroids 1mg kg /body weight/ -21 day
tapering over 15 days and physiotherapy.
• Ongoing observation did by close follow up with EMG.
• Failure of clinical recovery by 4 months or any signs
of nerve degeneration as noted on EMG designated
as indications for surgical treatment.
>20 20-40 40-60
Longitudinal # remain the most common fracture in post traumatic facial
our experience indicates that surgical
need not be the only recommneded
In Post traumatic facial palsy treatment
of choice can be conservative with
close follow up and monitoring with
nerve conduction test.